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J Neurosurg. 2018 Mar 1:1-11. doi: 10.3171/2017.7.JNS162783. [Epub ahead of print]

Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience.

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1Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
2Department of Neurosurgery, Michael E. DeBakey VA Medical Center/Baylor College of Medicine, Houston, Texas.
3Otolaryngology and.
4Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada; and Departments of.


OBJECTIVEEpidermoid and dermoid cysts may be found along the cranial base and are commonly resected via open transcranial approaches. The use of endoscopic endonasal approaches for resection of these tumors has been rarely reported.METHODSThe authors retrospectively reviewed the medical records of 21 patients who underwent endoscopic endonasal surgery for epidermoid and dermoid cyst resection at the University of Pittsburgh Medical Center between January 2005 and June 2014. Surgical outcomes and variables that might affect the extent of resection and complications were analyzed.RESULTSTotal resection (total removal of cyst contents and capsule) was achieved in 8 patients (38.1%), near-total resection (total removal of cyst contents, incomplete removal of cyst capsule) in 9 patients (42.9%), and subtotal resection (incomplete removal of cyst contents and capsule) in 4 patients (19%). Larger cyst volume (≥ 3 cm3) and intradural location (15 cysts) were significantly associated with nontotal resection (p = 0.008 and 0.0005, respectively). In the whole series, surgical complications were seen in 6 patients (28.6%). No complications were observed in patients with extradural cysts. Among the 15 patients with intradural cysts, the most common surgical complication was postoperative CSF leak (5 patients, 33.3%), followed by postoperative intracranial infection (4 patients, 26.7%). Larger cysts and postoperative CSF leak were associated with intracranial infection (p = 0.012 and 0.028, respectively). Subtotal resection was marginally associated with intracranial infection when compared with total resection (p = 0.091). All patients with neurological symptoms improved postoperatively with the exception of 1 patient with unchanged abducens nerve palsy.CONCLUSIONSEndoscopic endonasal approaches may be effectively used for resection of epidermoid and dermoid cysts in carefully selected cases. These approaches are recommended for cases in which a total or near-total resection is possible in addition to a multilayer cranial base reconstruction with vascularized tissue to minimize the risk of intracranial infection.


CN = cranial nerve; CPA = cerebellopontine angle; EEA = endoscopic endonasal approach; EES = endoscopic endonasal surgery; ICA = internal carotid artery; dermoid cysts; endoscopic endonasal approaches; epidermoid cysts; outcome; postoperative intracranial infection; skull base


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